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PubMed1971

[Trial forceps].

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Birth Injuries↗
PubMed1975

The elderly primigravida.

A five-year review of 127 elderly patients (35 years of age and over), in their first pregnancies, defines the risk to the fetus in terms of perinatal death and neonatal morbidity. With the equivalent of a perinatal mortality rate of 94/1,000, an 11 per cent incidence of small-for-dates infants, and a neonatal morbidity rate of 18 per cent, there would still appear to be a need for an increased awareness of the fetal risks in this group and an increased emphasia on their prevention. Areas of management in prenatal care and labor which might reduce these figures are defined.

Adult↗
PubMed1983

Randomized management of the nonfrank breech presentation at term: a preliminary report.

Cesarean section has become the standard management used by many clinicians for breech presentation in labor. Proof of the superiority of routine cesarean section has been largely circumstantial. Concern over rising cesarean section rates has led to renewed interest in possible alternatives. Protocols have been developed to select which patients may be allowed a trial of labor with frank breech presentation at term. We undertook a prospective clinical trial comparing elective cesarean section with a selective management protocol for the nonfrank breech presentation at term. One hundred five patients with nonfrank breech presentations at term in labor were studied. Seventy (67%) were randomized to a trial of labor and 35 (33%) to elective cesarean section. Of the patients allowed a trial of labor, 31 (44%) were delivered vaginally, and 39 (56%) required cesarean section. The largest single cause of a "failed" trial of labor was inadequate pelvic dimensions on x-ray pelvimetry (23 patients, 59%). Neonatal morbidity assessed by Apgar scores, cord gases, birth injury, and hospital stay was not different for those delivered vaginally or by cesarean section. Maternal morbidity in terms of febrile morbidity, blood transfusion, wound infections, and hospital stay was significantly greater among women delivered by cesarean section. Two of three neonatal deaths occurred in infants with major congenital anomalies. The third infant, apparently normal, died after vaginal delivery. Extensive evaluation suggests the death was attributable to inadequate resuscitation. We conclude that the use of a selective management protocol under controlled conditions is a reasonable alternative to elective cesarean section. Approximately one half of patients allowed a trial of labor may be expected to deliver vaginally with neonatal morbidity comparable to that seen with cesarean section.

Adult↗
PubMed1994

Differences in obstetrical intervention rates between Dutch hospitals.

Within the framework of the project 'Obstetric Peer Review' (Verloskundige Onderlinge Kwaliteitsspiegeling, VOKS) differences between Dutch hospitals concerning various obstetrical interventions were investigated. Using data of the Perinatal Database of the Netherlands from hospitals with at least 2000 newborns in the 5-year period 1987-1991, remarkable differences in frequencies of labour induction, caesarean section and vaginal operative deliveries can be shown, even when these interventions were considered within homogeneous subgroups with respect to pregnancy- or delivery-related complications. The incidence of caesarean section (and labour induction and vaginal operative delivery) appeared to depend more on the specific hospital policy than might be explained by populations differences alone. These intervention differences between hospitals clearly demonstrated the need to carry out a multivariate analysis to compare hospitals in a relevant and unbiased way, while adjusting for these population differences. This will estimate the intervention risks in a way which allows a fair comparison of hospital intervention policies.

Cesarean Section↗
PubMed2004

Changing times.

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Cesarean Section↗
PubMed2005

Mode of delivery and problems in subsequent births: a register-based study from Finland.

OBJECTIVE: The purpose of this study was to investigate the effects of delivery on problems in subsequent births. STUDY DESIGN: This was a cohort study that used register data for 73,104 mothers who had their first birth from 1987 to 1989 and subsequent births from 1987 to1998. Three analyses were performed: (1) examination of second births by mode of delivery in the first birth, with adjustment for confounders, (2) same parameter, with exclusion of women with persistent problems, and (3) examination of third births for women with a first birth vaginal delivery. RESULTS: More complications and poorer infant outcome were found at later births when the first or second birth was by cesarean delivery than after a first spontaneous vaginal delivery, even when women with persistent problems were excluded. Women with instrument first births had a similar rate of complications in the second birth to women with spontaneous vaginal births, but some infant outcomes were poorer. CONCLUSION: Problems that are subsequent to cesarean delivery are unlikely to be explained entirely by indications for cesarean delivery.

Cesarean Section↗
PubMed2006

Are the Agency for Healthcare Research and Quality obstetric trauma indicators valid measures of hospital safety?

OBJECTIVE: The objective of the study was to examine whether the United States Agency for Health Care Research and Quality obstetric patient safety indicators are significantly affected by patient-specific and hospital-level characteristics not related to the safety environment. STUDY DESIGN: Administrative data for all nonfederal Illinois hospitals in 2001 were used to analyze the association of a hospital's obstetric trauma rates with patient and hospital-level factors. Multivariable random effects logistic regression analyses was used to account for hospital-level clustering. RESULTS: A total of 175,374 deliveries from 142 Illinois hospitals were available for analysis. The frequency of obstetric trauma was significantly associated with multiple patient-specific and hospital-level factors. Specifically, for any vaginal delivery, premature delivery, multiple gestation, excessive fetal growth, and prolonged pregnancy was associated with obstetric trauma risk. For spontaneous delivery, a prior cesarean was associated with trauma risk as well. Maternal age was associated with trauma risk at cesarean as well as at vaginal delivery. With regard to hospital-level factors, a higher annual delivery volume and a higher cesarean rate were associated with increased risk of trauma with either type of vaginal delivery, whereas in the intensity with which hospitals coded their medical records was associated with trauma risk for all routes of delivery. CONCLUSION: The risk of obstetric trauma is significantly influenced by both patient and hospital characteristics and is not a good indicator of patient safety.

Cesarean Section↗
PubMed1985

Advanced maternal age: the mature gravida.

A 3-year study of women ages 35 years and older who were delivered at Women's Hospital of Long Beach from January 1, 1981, to December 31, 1983, was performed to study the risks involved with advanced maternal age. The study group included 1023 women who were 35 years and older, and they were divided into parous and nulliparous groups. A control group consisting of 5343 women aged 20 to 25 years was used for comparison. Each group was analyzed for the following parameters: pregnancy complications, labor complications, delivery factors, and neonatal outcome. The results show very few statistical differences in the factors analyzed. On the basis of this 3-year study it appears that pregnancies in women of advanced maternal age in the 1980s who are delivered in a modern tertiary care center may be of no higher risk for adverse outcome than pregnancies in younger parturients.

Adult↗
PubMed1996

Operative vaginal delivery--year 2000.

Literature review was performed to analyze and define the current state of operative vaginal delivery. On the basis of published data, it is concluded that outlet and low forceps deliveries with < or = 45 degrees of rotation are effective and safe for both mother and baby. The greatest risk to mother or fetus occurs with operations performed at the 0 or +1 station or those involving rotations > 45 degrees. It is likely that operative deliveries involving > 45 degrees of rotation will be abandoned in the future. It is further recommended that The American College of Obstetricians and Gynecologists 1988 forceps classification system be adopted for deliveries by vacuum extractors.

Delivery, Obstetric↗
PubMed1997

Incidence of persistent birth injury in macrosomic infants: association with mode of delivery.

OBJECTIVE: Our purpose was to determine the incidence of birth injury in a cohort of macrosomic infants (birth weight >4000 gm) and analyze the association between persistent injury and delivery method. STUDY DESIGN: Deliveries of 2924 macrosomic infants were reviewed. Outcomes were compared with those of 16,711 infants with birth weights between 3000 and 3999 gm. RESULTS: Macrosomic infants had a sixfold increase in significant injury relative to controls (relative risk 6.7,95% confidence interval 6.5 to 6.9). Risk of trauma correlated with delivery mode: forceps were associated with a fourfold risk of clinically persistent findings compared with spontaneous vaginal delivery or cesarean section. However, the overall incidence of persistent cases remained low (0.3%); a policy of elective cesarean section for macrosomia would necessitate 148 to 258 cesarean sections to prevent a single persistent injury. Avoidance of operative vaginal delivery would require 50 to 99 cesarean sections per injury prevented. CONCLUSIONS: These findings support a trial of labor and judicious operative vaginal delivery for macrosomic infants.

Birth Injuries↗
PubMed2002

Breast-feeding and its relation to smoking and mode of delivery.

OBJECTIVE: To examine the effects of cesarean and forceps or vacuum delivery and parental smoking habits on the initiation and duration of breast-feeding. METHODS: We conducted a prospective, population-based birth cohort study in 1997. Data were collected on breast-feeding history, household smoking habits, method of delivery, and other demographic, obstetric, behavioral, and potential confounding variables via a standardized self-administered questionnaire. Multivariable logistic regression was used to examine the association between method of birth (cesarean versus forceps or vacuum delivery versus normal vaginal birth) and either not initiating breast-feeding or doing so for less than 1 month. Among women who breast-fed for 1 month or more, multivariable survival analysis was employed to study the relationship between method of delivery and breast-feeding duration. We repeated these analyses to examine the link between parental smoking habits and breast-feeding initiation and duration. RESULTS: A total of 7825 mother-infant pairs were followed up for 9 months. Cesarean delivery was a risk factor for not initiating breast-feeding, for breast-feeding less than 1 month, and remained a significant hazard against breast-feeding duration. Assisted delivery with forceps or vacuum, although not associated with breast-feeding initiation, was a significant risk against breast-feeding duration. Conversely, current parental smoking habits only affected breast-feeding initiation but were unrelated to breast-feeding duration. CONCLUSION: This study indicates a possible effect of forceps or vacuum delivery on breast-feeding and of cesarean on long-term breast-feeding duration. The findings provide additional evidence in support of the avoidance of unnecessary obstetric interventions.

Breast Feeding↗